The purpose of this study was to compare the outcomes of arthroscopic unilateral surgery and simultaneous bilateral surgery for posterior ankle impingement syndrome (PAIS) in athletes and to evaluate the usefulness of simultaneous bilateral surgery. A total 48 hindfeet of 41 athletes (14 hindfeet of 14 males, 34 hindfeet of 27 females) who underwent arthroscopic surgery for PAIS were studied. Japanese society for surgery of the foot (JSSF) score and visual analogue scale (VAS) were compared before and after surgery, using Wilcoxon signed-rank test. The operation time and the time to return to sports activity were compared in 10 hindfeet of 5 patients who underwent simultaneous bilateral surgery and 38 hindfeet of 36 patients who underwent unilateral surgery, using Wilcoxon rank sum test. Classic ballet was the most common type of sport that caused PAIS (59%, 24/41 athletes). Soccer (10%, 4/41 athletes), baseball (10%, 4/41 athletes), badminton (5%, 2/41 athletes), volleyball (5%, 2/41 athletes), and athletics (5%, 2/41 athletes) followed. The JSSF score improved significantly from 72.7 preoperatively to 98.9 postoperatively in unilateral surgery, and significantly improved from 75.2 preoperatively to 99.0 postoperatively in simultaneous bilateral surgery. VAS significantly decreased from 64.7 preoperatively to 4.8 postoperatively in unilateral surgery, and significantly decreased from 72.7 preoperatively to 1.0 postoperatively in simultaneous bilateral surgery. The operating time was 53.7 minutes on average for unilateral surgery and 101.0 minutes for simultaneous bilateral surgery, significantly longer in bilateral simultaneous surgery. The mean time to return to sports activity was 4.8 weeks for unilateral surgery and 9.6 weeks for simultaneous bilateral surgery, significantly longer in simultaneous bilateral surgery. Both unilateral and simultaneous bilateral surgeries for PAIS in athletes were useful. It should be noted that the operating time and the time to return to sports will be longer. However, considering the 2 times hospitalizations and 2 times surgeries, simultaneous bilateral surgery is one of the treatment options for PAIS

Orthopaedic surgeons prescribe more opioids than any other surgical speciality. Opioids remain the analgesic of choice following arthroscopic knee and shoulder surgery. There is growing evidence that opioid-sparing protocols may reduce postoperative opioid consumption while adequately addressing patients’ pain. However, there are a lack of prospective, comparative trials evaluating their effectiveness. The objective of the current randomized controlled trial (RCT) was to evaluate the efficacy of a multi-modal, opioid-sparing approach to postoperative pain management in patients undergoing arthroscopic shoulder and knee surgery. The NO PAin trial is a pragmatic, definitive RCT (NCT04566250) enrolling 200 adult patients undergoing outpatient shoulder or knee arthroscopy. Patients are randomly assigned in a 1:1 ratio to an opioid-sparing group or standard of care. The opioid-sparing group receives a three-pronged prescription package consisting of 1) a non-opioid prescription: naproxen, acetaminophen and pantoprazole, 2) a limited opioid “rescue prescription” of hydromorphone, and 3) a patient education infographic. The control group is the current standard of care as per the treating surgeon, which consists of an opioid analgesic. The primary outcome of interest is oral morphine equivalent (OME) consumption up to 6 weeks postoperatively. The secondary outcomes are postoperative pain scores, patient satisfaction, quantity of OMEs prescribed and number of opioid refills. Patients are followed at both 2 and 6 weeks postoperatively. Data analysts and outcome assessors are blinded to the treatment groups. As of December 1, 2021 we have enrolled 166 patients, reaching 83% of target enrolment. Based on the current recruitment rate, we anticipate that enrolment will be completed by the end of January 2022 with final follow-up and study close out completed by March of 2022. The final results will be released at the Canadian Orthopaedic Association Meeting in June 2022 and be presented as follows. The mean difference in OME consumption was XX (95%CI: YY-YY, p=X). The mean difference in OMEs prescribed was XX (95%CI: YY-YY, p=X). The mean difference in Visual Analogue Pain Scores (VAS) and patient satisfaction are XX (95%CI: YY-YY, p=X). The absolute difference in opioid refills was XX (95%CI: YY-YY, p=X). The results of the current study will demonstrate whether an opioid sparing approach to postoperative outpatient pain management is effective at reducing opioid consumption while adequately addressing postoperative pain in patients undergoing outpatient shoulder and knee arthroscopy. This study is novel in the field of arthroscopic surgery, and its results will help to guide appropriate postoperative analgesic management following these widely performed procedures

Aim: To determine the effectiveness of arthroscopic surgery, without excision of the radial head, in elbows with end stage arthritis of the radiocapitellar joint. Methods: Twenty-three elbows with bone-on-bone degeneration of the radio-capitellar joint, but with only minor degeneration of the humeroulnar joint, had arthroscopic surgery, with synovectomy, removal of loose bodies and excision of impinging tissues and bone. The average age was 51 years (range: 16 years to 59 years). Evaluation was by a questionnaire and the follow-up was after a minimum of one year. Results: The average follow up was 41 months (range 12 months to 83 months). Twenty-one of 22 patients reported improvements. Six patients were pain free, 12 had mild residual pain and six had significant, continuing pain. Only three patients reported residual lateral elbow pain. The average visual analogue pain score was 3.4. According to the Mayo elbow function score, there were eight excellent, seven good, six fair, and three poor outcomes. Conclusions: Satisfactory improvements in symptoms and function were obtained in arthritic elbows with arthroscopic surgery, even in the presence of severe radiocapitellar arthritis

Arthroscopic surgery performed on the medial or lateral compartments of the knee most commonly involves resection or repairs of tears of the posterior horns of the menisci. In osteoarthritic, anterior cruciate ligament-deficient, ligamentously tight, or very large adult knees, arthroscopic surgery through the conventional anterolateral and antero-medial ports can be difficult. It often gives rise to the risk of iatrogenic damage to the articular surfaces and structures of the knee. Establishing an accessory medial and/or lateral port for instrumentation has proved an easy and safe technique in conducting arthroscopic surgery to the posterior (medial and/or lateral) compartments of the knee. This technique was used on 103 patients where access to the posterior compartments of the knee proved problematic. The technique is simple but highly effective and safe and is recommended for the inexperienced arthroscopist

Arthroscopic surgery is a common intervention for osteoarthritis of the knee. However, the benefits from such an intervention are not clear. The purpose of the study was to perform a questionnaire survey of orthopaedic surgeons of Wales to analyse the practice of arthroscopy for osteoarthritic knee. Over a three-month period, a postal survey was conducted of all hospital orthopaedic consultants in Wales. Of a total of 62 questions sent we received a reply of 37. 31 surgeons perform arthroscopic lavage or debride-ment. 4 surgeons perform arthroscopic surgery for symptomatic meniscal tear only. There was no defined protocol regarding the management. Early OA was the commonest indication (18). Arthroscopic lavage (17) was equally popular to lavage and debridement (16). 6 respondents like to perform the surgery themselves while the majority would allow a middle grade surgeon to operate with or without supervision. 26 surgeons felt that the results of the procedure are unpredictable, but still continued to perform it. Only 6 surgeons felt a continued relevance of the procedure. Arthroscopic surgery is a commonly performed symptomatic treatment for arthritic knee. It bears a significant financial commitment. 266 arthroscopic knee surgery were performed annually in a district general hospital, of whom 115 were arthroscopic washout. Average cost of each operation is £1000. The physiological basis for arthroscopic washout is not clear. A majority of the Welsh surgeons have reservations about this procedure. In spite of evidence of limited usefulness, it is still performed widely

Tears of the posterior horn of the menisci often call for arthroscopic surgery to the medial or lateral compartments of the knee. In osteoarthritis knees, or when there is anterior cruciate ligament deficiency or joint tightness, using conventional anterolateral and anteromedial portals can be difficult. This is so also in very large adult knees. There is a risk of iatrogenic damage to the articular surfaces and structures of the knee. The establishment of an accessory medial and/or lateral portal for instrumentation makes it easy and safe to perform arthroscopic surgery to the posterior medial and/or lateral compartments. The author used this technique in 103 patients in whom access to the posterior compartments was problematic. The simple but effective technique is particularly useful for the inexperienced surgeon or arthroscopist in training

Purpose: Disposable medical devices have several advantages and are widely used. But since the financial burden of disposable devices is however significant for the hospital budget, it would be interesting to reassess multiple use devices in terms of efficacy and safety. The purpose of this study was to determine the safety aspects involved and to assess wear observed in new versions of autoclavable shavers and drill bits used in arthroscopic surgery. Material and methods: After standard preparation and ten sterilisation cycles, fifteen instruments (shavers and drill bits) were used 10 times each during arthroscopic procedures performed on non-embalmed cadavers. The instruments were used on tissues, cartilage or tendons (shavers) or cancellous bone (drill bits). Duration of use was at least 10 min for each instrument. The instruments underwent standard preparation (decontamination-cleaning-immersion in 1N caustic solution) followed by sterilisation at 134°C for 20 minutes as defined by the regulatory decree (n° 138, 14 March 2001). A tracability sheet was completed at each order for sterilisation. The first phase consisted in an evaluation of the instrument’s resistance to sterilisation treatments, in particular the non-alteration of the cutting surface examined under optical magnification. The second phase was to determine the feasibility and performance level of the cleaning step based on assay of protein residue with UV spectrophotometry as described by Bradford. Results: One hundred fifty complete cycles were performed. The results of the first phase demonstrated satisfactory instrument resistance to 10 uses with traces of erosion visible on 20% of the instruments after the 5th use. Two instruments were replaced during the study due to mechanical wear. The second phase revealed positive results in 2% of the cases (residual proteins > 8 μg/ml), the positivity threshold defined by the Pr EN ISO 15883-1 normalisation project concerning general requirements for desinfecting cleaners. Analysis of these results demonstrated that 12% of the instruments cleaned with ultrasounds carried traces of protein residues. There was no trace of proteins on instruments cleaned with a washing machine operating on the “endoscope” cycle, i.e. 143 successive cycles. Discussion: Despite the difficulty in cleaning (double sheath), shavers and drill bits used in arthroscopic surgery can be reused without risk since the traces of residual protein are negligible when the instruments are cleaned with a endoscope-quality desinfecting washing machine. In addition, despite intensive use, wear is acceptable for ten cycles. Extensive use of disposable instruments should be carefully debated due to the financial consequences

Purpose : The purpose of this study is to assess the effectiveness of the arthroscopic method in the stiffness of elbow after osteoarthritis or posttraumatic arthritis. Materials and methods : In the time period January 1999 to December 2001, 11 patients with primary osteoarthritis and posttraumatic arthritis of the elbow were treated in our clinic with the arthroscopic method. All patients had stiffness and pain. Nine of them were men and two women with a mean age of 46 years (range 28–56 years). Average preoperative flexion was to 1150 (range 90 – 1400), and average extension loss was −250 (range 15 – 350). Mean follow-up was 30,3 months. Results : The range of motion showed a progressive increase until 1 year after surgery. However, after 1 year, the range of motion showed little additional increase, especially in laborers. The range of motion acquired during surgery usually was the same range that patients achieved during the rehabilitation period. Average postoperative flexion was to 1380 (range 120 – 1430) and average extension was to 50 (range 0 – 120). The range of motion showed more improvement in patients whose duration of symptoms was less than 1 year than in those whose duration of symptoms was longer than 1 year. All patients had a significant decrease in pain and 5 of them complete relief of pain. Conclusions : The arthroscopic surgery in the stiffness of elbow after osteoarthritis and posttraumatic arthritis is a minimally invasive procedure with significant results in range of motion and pain relief

Since its creation, labral repair has become the preferred method among surgeons for the arthroscopic treatment of acetabular labral tears resulting in pain and dysfunction for patients. Labral reconstruction is performed mainly in revision hip arthroscopy but can be used in the primary setting when the labrum cannot be repaired or is calcified. The purpose of this study was to compare the survival between primary labral repair and labral reconstruction with survival defined as no further surgery (revision or total hip replacement).

Patients who underwent labral repair or reconstruction between January 2005 and December 2018 in the primary setting were included in the study. Patients were included if they had primary hip arthroscopy with the senior author for femoroacetabular impingement (FAI), involving either labral reconstruction or labral repair, and were within the ages of 18 and 65 at the time of surgery. Exclusion criteria included confounding injuries (Leggs Calves Perthes, avascular necrosis, femoral head fracture, etc.), history of unilateral or bilateral hip surgeries, or Tönnis grades of 2 or 3 at the time of surgery. Labral repairs were performed when adequate tissue was available for repair and labral reconstruction was performed when tissue was absent, ossified or torn beyond repair.

A total of 501 labral repairs and 114 labral reconstructions performed in the primary setting were included in the study. Labral reconstruction patients were older (37±10) compared to labral repair (34±11).(p=0.021). Second surgeries were required in 19/114 (17%) of labral reconstruction and 40/501(8%) [odds ratio: 2.3; 95% CI 1.3 to 4.2] (p=0.008). Revision hip arthroscopy were required in 6/114(5%) labral reconstructions and 33/501(6.5%) labral repair (p=0.496). Total hip replacement was required in 13/114 labral reconstructions and 7/501 labral repairs [odds ratio:9.1 95%CI 3.5 to 23] (p=< 0.01). The mean survival for the labral repair group was 10.2 years (95%CI:10 to 10.5) and 11.9 years (98%CI:10.9 to 12.8) in the labral reconstruction group.

Conversion to total hip was required more often following primary labral reconstruction. Revision hip arthroscopy rates were similar between groups as was the mean survival, with both over 10 years. Similar survival was seen in labral repair and reconstruction when strict patient selection criteria are followed.

Aims: The re-dislocation rates in adults (< 30 years) in the initial 12 months after FAT (first,anterior,traumatic) shoulder dislocations treated non-operatively vary from 25% to 95%. Some surgeons advocate early arthroscopic surgery following such dislocations as this appears to reduce recurrent instability. The purpose of this study was to establish if arthroscopic surgery reduces the incidence of recurrent instability after such dislocations when compared to non-operative treatment. Material and Methods: Specific search terms were used to retrieve relevant studies from MEDLINE, EMBASE, and CINAHL extending from 1966 to October 2003. Guidelines for reporting of meta-analysis, adapted from QUOROM statement were followed. Adults under 30 years of age, with clinical and radiological confirmation of anterior dislocation following trauma with a minimum follow-up of 12 months were included. Patients with previous shoulder problems, generalised joint laxity, neurological injury, impingement and a history of substance abuse were excluded. Results: 13 studies involving 433 shoulders were reviewed. Group A included 84 shoulders treated by arthroscopic lavage without stabilisation. There were no subluxations. The re-dislocation rate was 14.3% (12/84). Group B had 179 shoulders treated by arthroscopic stabilisation. The incidence of subluxation was 5.02% (9/179) and dislocation was 6.14% (11/179). Recurrent instability (subluxation /dislocation) following arthroscopic lavage (12/84 – 14.3%) was significantly higher than after arthroscopic stabilisation (20/179 – 11.2%). [p= 0.04, Relative risk = 2.32, 95% CI: 1.07 to 5.05]. Group C involved 170 shoulders treated non-operatively. The incidence of subluxation was 8% (12/150) and dislocation was 62% (93/150). The overall incidence of recurrent instability was 70% (119/170). Recurrent instability following arthroscopic intervention (32/263 – 12.2%) was significantly lower than following non-operative treatment (119/170 – 70%) [p< 0.0001, Relative risk = 0.17, 95% CI: 0.12 to 0.24]. Conclusion: Early arthroscopic surgery reduces recurrent instability during the initial 12 months after FAT shoulder dislocation in young adults (< 30 years) when compared to non-operative treatment. Arthroscopic treatment should be offered to young, athletic patients especially those involved in contact sports or defence personnel, who are at a high risk of recurrent instability after initial shoulder dislocation. Further randomised control trials reporting on a larger number of patients with a minimum follow-up of 5 years are required before one can draw firm conclusions on the ability of arthroscopic intervention to influence the natural history of FAT shoulder dislocation

Aim: The re-dislocation rates in adults (< 30 years) in the initial 12 months after first, anterior, traumatic (FAT) shoulder dislocations treated non-operatively vary from 25% to 95%. The purpose of this study was to establish if arthroscopic surgery reduces the incidence of recurrent instability (failure) after such dislocations when compared to non-operative treatment. Material and Methods: Specific search terms were used to retrieve relevant studies from various databases extending from 1966 to May 2004. Guidelines for reporting of meta-analysis, adapted from QUOROM statement were followed. Results: 13 studies involving 433 shoulders were reviewed. Group A included 84 shoulders treated by arthroscopic lavage without stabilisation. There were no subluxations. The re-dislocation rate was 14.3% (12/84). Group B had 179 shoulders treated by arthroscopic stabilisation. The incidence of subluxation was 5.02% (9/179) and dislocation was 6.14% (11/179). Failure following arthroscopic lavage (12/84 – 14.3%) was significantly higher than after arthroscopic stabilisation (20/179 – 11.2%). [p= 0.04, Relative risk = 2.32, 95% CI: 1.07 to 5.05]. Group C involved 170 shoulders treated non-operatively. The incidence of subluxation was 8% (12/150) and dislocation was 62% (93/150). The overall incidence of failure was 70% (119/170). Failure following arthroscopic intervention (32/263 – 12.2%) was significantly lower than following non-operative treatment (119/170 – 70%) [p< 0.0001, Relative risk = 0.17, 95% CI: 0.12 to 0.24]. Conclusion: Early arthroscopic surgery appears to reduce recurrent instability during the initial 12 months after FAT shoulder dislocation in young adults (< 30 years) when compared to non-operative treatment. Arthroscopic stabilisation may be considered for young, athletic patients and those involved in contact sports or defence personnel, who are at a high risk of recurrent instability after FAT shoulder dislocation. RCTs reporting on a larger number of patients with a minimum follow-up of 5 years are required before one can draw firm conclusions on the ability of arthroscopic intervention to influence the natural history of traumatic anterior shoulder dislocation

Malnutrition is an important consideration during the perioperative period and albumin is the most common laboratory surrogate for nutritional status. The purpose of this study is to identify if preoperative serum albumin measurements are predictive of infection following arthroscopic procedures.

Patients undergoing knee, shoulder or hip arthroscopy between 2006–2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with an arthroscopic current procedural terminology code and a preoperative serum albumin measurement were included. Patients with a history of prior infection, including a non-clean wound class, pre-existing wound infection or systemic sepsis were excluded. Independent t-tests where used to compare albumin values in patients with and without the occurrence of a postoperative infection. Pre-operative albumin levels were subsequently evaluated as predictors of infection with logistic regression models.

There were 31,906 patients who met the inclusion criteria. The average age was 55.7 years (standard deviation (SD) 14.62) and average BMI was 31.7 (SD 7.21). The most prevalent comorbidities were hypertension (49.2%), diabetes (18.4%) and smoking history (16.9%). The average preoperative albumin was 4.18 (SD 0.42). There were 45 cases of superficial infection (0.14%), 10 cases of wound dehiscence (0.03%), 17 cases of deep infection (0.05%), 27 cases of septic arthritis or other organ space infection (0.08%) and 95 cases of any infection (0.30%). The preoperative albumin levels for patients who developed septic arthritis (mean difference (MD) 0.20, 95% CI, 0.038, 0.35, P = 0.015) or any infection (MD 0.14, 95% CI 0.05, 0.22, P = 0.002) were significantly lower than the normal population. Additionally, disseminated cancer, Hispanic race, inpatient status and smoking history were significant independent risk factors for infection, while female sex and increasing albumin were protective towards developing any infection. Rates of all infections were found to increase exponentially with decreasing albumin. The relative risk of infection with an albumin of 2 was 3.46 (95% CI, 2.74–4.38) when compared to a normal albumin of 4. For each albumin increase of 0.69, the odds of developing any infection decreases by a factor of 0.52.

This study suggests that preoperative serum albumin is an independent predictor of septic arthritis and all infection following elective arthroscopic procedures. Although the effect of albumin on infection is modest, malnutrition may represent a modifiable risk factor with regard to preventing infection following arthroscopy.

The primary treatment goal for patients with femoroacetabular impingement syndrome, a common hip condition in athletes, is to improve pain and function. In selected patients, in the short term following intervention, arthroscopic hip surgery is superior to a pragmatic NHS- type physiotherapy programme. Here, we report the three-year follow-up results from the FemoroAcetabular Impingement Trial (FAIT), comparing arthroscopic hip surgery with physiotherapy in the management of patients with femoroacetabular impingement (FAI) syndrome. Two-group parallel, assessor-blinded, pragmatic randomised controlled study across seven NHS England sites. 222 participants aged 18 to 60 years with FAI syndrome confirmed clinically and radiologically were randomised (1:1) to receive arthroscopic hip surgery (n = 112) or physiotherapy and activity modification (n = 110). We previously reported on the hip outcome score at eight months. The primary outcome measure of this study was minimum Joint Space Width (mJSW) on Anteroposterior Radiograph at 38 months post randomisation. Secondary outcome measures included the Hip Outcome Score and Scoring Hip Osteoarthritis with MRI (SHOMRI) score. Minimum Joint Space Width data were available for 101 participants (45%) at 38 months post randomisation. Hip outcome score and MRI data were available for 77% and 62% of participants respectively. mJSW was higher in the arthroscopy group (mean (SD) 3.34mm (1.01)) compared to the physiotherapy group (2.99mm (1.33)) at 38 months, p=0.017, however this did not exceed the minimally clinically important difference of 0.48mm. SHOMRI score was significantly lower in the arthroscopy group (mean (SD) 9.22 (11.43)) compared to the physiotherapy group (22.76 (15.26)), p-value <0.001. Hip outcome score was higher in the arthroscopy group (mean (SD) 84.2 (17.4)) compared with the physiotherapy group (74.2 (21.9)), p-value < 0.001). Patients with FAI syndrome treated surgically may experience slowing of osteoarthritisprogression and superior pain and function compared with patients treated non- operatively

Background

Elite performance has tremendous physical demands and places elite athletes at an increased risk of sustaining a variety of orthopaedic injuries (1–4). Pain around the hip is common in high-level athletes representing up to 6% of all athletic injuries (5–7). Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. The purpose of this systematic review was to evaluate the outcome and the rate of return to play (RTP) following hip arthroscopy in elite athletes.

The technique of arthroscopic decompression of patellar tendonitis was first undertaken in 1990. We report the 10 year experience of using this technique. Patients presenting with this condition were subjected to clinical, radiological and MRI assessment. The procedure was undertaken if the symptoms continued to be significant despite non-operative treatment. The procedure used a Dyonics shaver. The fat pad was elevated from the bare area of the patella to expose the non-articular inferior pole of the patella. The tendon fibres were then elevated from the anterior surface of the inferior pole, and the 5mm tip of the patella was excised taking particular care to ensure that the full AP thickness was removed.

Seventy three knees underwent surgery with a minimum of one year follow up, in four cases a simultaneous bilateral procedure was performed and in 11 cases previous surgery had been performed elsewhere. The average age was 33 years, 64 of the cases were male. The average duration of symptoms was 20 months and all patients had undergone non-operative treatment prior to the index procedure for an average duration of 10 months. The average duration of follow up was 49 months. All patients experienced a significant improvement in the clinical grade of symptoms and function with 95% of the 62 primary cases resulting in a good or excellent result. The average time to return to work and driving was 2 weeks and to sport was 9 weeks. In the 11 revision cases, 9 (81%) were improved and 6 (55%) had a good result.

The results of arthroscopic decompression for patellar tendonitis are superior to the other reported techniques. We conclude that excision of the inflammatory nodule and fat pad in this condition is unnecessary, other than to obtain visualisation of the inferior pole of the patella. The success of this procedure supports the suggestion that this condition is produced by a compression of the tendon and is best treated by decompression of the inferior patella pole.

Recently concerns have been raised as to the effect of intra-articular radio-frequency energy on axillary nerve function. In our unit 120 shrinkage procedures have been performed with 5 intra-operative contractions of deltoid and no axillary nerve palsy. In this study we aimed to identify and quantify any changes in axillary nerve function following capsular shrinkage. Needle electrodes were inserted into the deltoid muscle of 10 patients undergoing radio-frequency capsular shrinkage and 3 patients having diagnostic arthroscopy. Recordings of Compound Muscle Action Potentials (CMAPs) were made following pre-operative magnetic coil stimulation of the axillary nerve. The nerve was then monitored during operation. At the end of the procedure, a further recording of CMAP following axillary nerve stimulation was made to allow comparison with initial readings.

We have shown:

Low amplitude stimulations of the axillary nerve in 6 of the 10 patients undergoing shrinkage.

We have concluded:-

Stimulation of the axillary nerve occurs frequently during capsular shrinkage.

We would like to acknowledge the Magstim Company for their assistance with this project.

Introduction: Acromioclavicular (AC) joint injuries are common in both the sporting and working populations. Most injuries are grade I in severity and settle with an appropriate non-operative treatment program.

Arthroscopic soft tissue debridement of the AC Joint without excising the distal clavicle, is a bone sparing procedure that, to our knowledge, has never been reported in the literature.

This paper is a retrospective review of patients with chronic recalcitrant AC joint injuries, who underwent arthroscopic soft tissue debridement of the AC joint.

Materials and Methods: Fourteen patients underwent arthroscopic AC joint soft tissue debridement. All patients had failed a non-operative treatment program including physiotherapy, anti-inflammatory tablets and corticosteroid injections. All patients had been symptomatic for a minimum of four months prior to surgery.

The surgery involves a glenohumeral joint arthroscopy, subacromial bursoscopy and AC joint arthroscopy. Excision of the torn AC joint meniscus, AC joint synovectomy and soft tissue clearance were performed in all cases. Surgery was performed as a day-only procedure.

Results: Ten out of fourteen patients obtained good pain relief and a corresponding increase in function. One patient was lost to follow-up. One patient subsequently underwent an open AC joint reconstruction for chronic instability.

Five patients had previously undiagnosed SLAP tears.

Conclusion

Arthroscopic soft tissue debridement for recalcitrant AC joint injuries gave good results in 77% of cases.

Introduction and purpose: One of the sequelae that patients with recurrent shoulder dislocation must face is a significant limitation of their capacities for daily living and sports activities. The purpose of treatment is the recovery of stability in order that patients can return to their activities with the as little loss of mobility and strength as possible. The aim of our study was to analyze the evolution of physical activity and correlate final stability with postoperative sports activity.

Materials and methods: We carried out a retrospective study on a sample of 30 patients diagnosed with recurrent shoulder dislocation who underwent surgery between January 2001 and May 2005. After a minimum 2 years’ follow-up, mobility and strength in the operated shoulder was assessed, comparing it to the contralateral limb; the stability and possible recurrence in the affected limb were also evaluated. Furthermore, at that time, data was collected on the sports activities of the patients.

Results: After more than 2 years’ follow-up a statistically significant decrease in the number of patients who performed high-risk sports was observed. Furthermore, in those patients who continued to practice high-risk sports after surgery, greater stability was seen in comparison with those patients who did not (p> 0.05).

Conclusions: Patients that undergo surgery for recurrent shoulder dislocation decrease their sports activities in comparison with their preoperative activities and the results of surgery are independent of postoperative sports activity.

This study presents the results of 60 consecutive hip arthroscopic procedures for the treatment of Acetabulo-Femoral Impingement. The procedures were performed by a single surgeon over a period of 36 months. The learning curve and the evolution of the current technique along with the clinical outcomes are discussed Additionally two new clinical signs of AFI are described, along with the correlation of radiological and arthroscopic findings.

Sixty patients underwent hip arthroscopies. The procedures included labral debridement, labral repair, femoral and/or acetabular osteectomies. All patients underwent MRI examination and three-dimensional CT imaging to identify the impingement lesion. Follow up CT scanning was performed to assess the accuracy of the bony resection. Patients were reviewed at three months and subsequently at twelve monthly intervals. All patients participated in completing questionnaires.

Post-operatively Modified Harris Hip score improved from 54 to 70, Non-Arthritic hip score improved from 58 to 75, SF12 score improved from 35 to 40. Three patients required a second procedure for further bony resection. One patient underwent a THR within 12 months. Two female patients suffered minor vaginal abrasions.

Hip arthroscopy is a demanding procedure. Good clinical results are achieved only when the cause of impingement has been identified and treated.

Hip arthroscopy has gradually evolved over the past two decades. Recently hip arthroscopy has an increasing role in diagnosis and treatment for specific intra articular and extra articular hip injuries and especially for soft tissue injuries.

February 2002 – May 2009

18 athletes

Mean age: 32 y.o. (19–39 y.o.)

Undiagnosed hip pain, Osteoarthritis, Labral pathology, Loose bodies, Osteochondral defects, Sepsis, Liga-mentum Teres, Trauma, Synovitis

Symptoms: Deep dull ache pain during hip flexion and external or internal rotation. Decreased R.O.M.

12/18 Cam sign + (positive), 11/18 Pincher sign + (positive), 14/18 Impingement syndrome in adduction and in flexion.

Instrumentation and Equipment: 30°, 70°, 4,5mm arthroscope, High flow rate mechanical pump, 15 gauge 6" cardiac needle, Convex full radius chondroplasty blades, Special electrocautery (Philippon), Distraction apparatus, Mechanical water pump unit, Image intensifier

Surgery: Standard orthopaedic traction table, Supine position, Hip is extended and abducted 25°

Detachment of the labrum, 2/18 erosion of the articular cartilage of the acetabulum and drilling of the bare area, 12/18 Cam sign excision

The athletes with symptoms of an internal hip pain and impingement signs after a clinical exam of their hip will get a benefit from an arthroscopic procedure for treating any existing cetabulo-femoral pathology, especially for the athletes with femoraloacetabular impingement syndrome (FAI).